Doctor Visit--Billing Insurance Question

[flex]

I had a doc appointment today. When I checked out, I was told the amount due, so I paid it. I stood there a minute because I thought I'd get a copy of the bill from her. After staring at the receptionist for a minute, she looked at me inquiringly. I said, "Hi, may I have a copy of the bill, please? I want to send it to my insuracne company for reimbursement".

She said, "Oh, we normally send your bill to your insurance and then we reimburse you". So wait---I've paid the full amount, but now I'm supposed to wait for my insurance send you the money (even it's not owed), and then I have to wait for your separate billing cycle to pay me, which will probably take more time than my insurance company?? Won't they basically be paid twice? It seems to be this will be additional income for them until they get around reimbursing me.

Is this a typcial practice? I'm not used to this if it is. It seems to me I'm eliminating the middle man, amirite?

Anyway, I got a copy of the bill and I'm mailing it today. Should take 2 weeks for my insurance to pay me back.

[mypunkinpie]

I had a dentist that did this. I hated it.

[bonquiqui]

No, it is not. Normally, they should submit to insurance, and wait for the payment or have you pay up front, and the provide you with claim. Typically though, they will submit for you, and you should just pay your copay.

[flex]

Jul 10, 2012 15:12:53 GMT -5 bonquiqui said:

No, it is not. Normally, they should submit to insurance, and wait for the payment or have you pay up front, and the provide you with claim. Typically though, they will submit for you, and you should just pay your copay.

Yeah, I understand all that. I am totally fine with paying the full amount if it's just a doc visit. But I have never paid up front then waited for the doc office to send in the bill. Why should the money go directly to them if I've already paid it?? Like I said in the OP, I think (and I could be completely wrong) that this is extra income for them once the insurance pays them until they pay me through their payment cycle.

[motzie]

I've never heard of this. Usually, they'll bill your insurance, say $300. Your insurance will pay them like $88 and you might be responsible for either nothing additional, or another amount depending on your policy.

[flex]

Yeah, my insurance pays 85% so I won't get the full amount reimbursed to me, which is fine.

I've been with my insurance company over 25 years, and this is the first time I've been seen this kind of a billing practice.

[mrsjuleshs]

I have never heard of having to do this. I always just pay my portion and they bill the rest to the insurance company or I pay up front and I submit my claim.

[motzie]

Jul 10, 2012 15:24:49 GMT -5 flex said:

Yeah, my insurance pays 85% so I won't get the full amount reimbursed to me, which is fine.

Yes, but 85% of what they allow, which is an entirely different number than what your office bills.

[flex]

There were no tests run--just a check-up. I'll be reimbursed 85% of the bill directly by my insurance company within two weeks. If I waited for the doc's office to do it, I'll bet you anything it would take up to a month to be reimbursed.

I say PHOOEY to that!

[motzie]

This sounds scam-ish to me. I'm guessing it is allowed but it sounds like an end run around getting paid the lower amounts that insurance allows. You get your money back, and the Doc gets the $300.

[oregonpachey]

If the provider is participating with your insurance company, they likely have something in their contract that they aren't allowed to collect any money from the patient. There are some exceptions to this however (dentists, some eye doctors).

I have actually called out a couple of offices for this and they always back pedal.

[flex]

Okay, I just called my insurance compnay, and they thought what happened was weird too. They have notated on my file that I paid in full, so when my copy of the doctor's bill reaches them, they'll know what's what. : )

[AngGee]

Ok so I'm just a lurker but also wanted to say, if you use a doctor in your plan they give the insurance companies discounts so you are only responsible for that amount. (well 85% of the discounted amount, in your case)
Make sense?

[flex]

Jul 10, 2012 16:15:00 GMT -5 AngGee said:

Ok so I'm just a lurker but also wanted to say, if you use a doctor in your plan they give the insurance companies discounts so you are only responsible for that amount. (well 85% of the discounted amount, in your case)
Make sense?

I know what you mean--you mean a Preferred Provider, right? We have a PP with a hospital so we have to go there or suffer financial consequences. But that doesn't apply to this doctor's office. I don't have to go threre. I could have gone to a different doctor.

But the point is not about the 85/15%, etc. The point is I paid the full bill up front, and then I expect my insurance company to reimburse me for 85% of that bill. I do NOT want the doctor's office to bill my insurance AGAIN after I've already paid for it. There is absolutely no reason why there should be a middle man involved here. None what so ever.

[starburst604]

They shouldn't be charging you up front when you have insurance. The only time I've seen this done is when it's known for sure that a patient hasn't satisfied their deductible. They SHOULD be submitting your claim, but not charging you out of pocket first. For anything. I've been a medical practice manager for 11 yrs and have never heard of anything like that. Although , it sounds like it isn't the first time that's happened to you, is it common practice in your state?

[marynjoe]

That happened to me once. The doctor got the reimbursement and never sent it to me. I finally had to make a huge deal out of it to get my money and they still acted like I was the one who did something wrong. I found a new doctor.

[flex]

Jul 10, 2012 16:54:12 GMT -5 starburst604 said:

They shouldn't be charging you up front when you have insurance. The only time I've seen this done is when it's known for sure that a patient hasn't satisfied their deductible. They SHOULD be submitting your claim, but not charging you out of pocket first. For anything. I've been a medical practice manager for 11 yrs and have never heard of anything like that. Although , it sounds like it isn't the first time that's happened to you, is it common practice in your state?

No, it's not a common thing for this state. I'm super suspicious about this doctor now, so I won't be going there again. And now my insurance company knows about it too.

[flex]

Jul 10, 2012 16:59:56 GMT -5 marynjoe said:

That happened to me once. The doctor got the reimbursement and never sent it to me. I finally had to make a huge deal out of it to get my money and they still acted like I was the one who did something wrong. I found a new doctor.

This is EXACTLY what I'm thinking might of happened if I hadn't stood up to her and asked for a copy of the bill.

[AngGee]

And as you said, even if they were to pay you back, how long would you have to wait on your money?? Probably 60 to 90 days. They will be making money off of YOUR money.
Wrong in so many ways! Glad you were on top of this!

[daisyheadmaizie]

I have been finding more and more lately that the doctor's office wants to collect money upfront for your estimated bill and then bill insurance, which is just wrong. For one, the amount they bill gets heavily discounted once it goes to insurance, so their estimates are always way off. I never pay a bill (minus copays) from any doctor until they have sent into insurance and I have a Explanation of Benefits in my hand from the insurance company. Usually once I remind the billing person, that I will wait and pay once my insurance has been processed and have received my EOB, they will back pedal and say that is fine.

[pbear]

That seems like more work for the doctor's office. And some offices won't give a refund until a patient specifically requests it, that's how it works at my company and I don't agree with it at all.